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Talking with children about cancer

When Rod Echols, colorectal cancer survivor, and his wife Keisha learned that Rod had cancer, they immediately thought about their two young children.

“Our son Preston was three at the time, and our daughter Pria was one,” says Keisha. “Pria was too young to understand, but Preston was three going on 15, so we couldn’t get away with not telling him.”  

Keisha and Rod described his cancer to Preston in a way that was age-appropriate without going into unnecessary details.  “We told him that daddy had an ‘ouchie’ that needed to be operated on and treated so it would go away,” says Keisha. “Once the cancer was in remission, we told Preston we needed to pray that daddy’s ‘ouchie’ stays gone.”

When a parent is diagnosed with cancer, there is inevitably a disruption in family life as well as the children’s daily routine. The way they deal with the emotions that come along with cancer will often depend on the child’s age and development.

“The most important thing for children to know while a parent is going through cancer treatment is that they are loved and will be cared for,” says Heather Swick, mind-body therapist at our hospital near Chicago.

Why talk to kids about cancer?

It may be tempting to try to avoid talking to your children about cancer. You may feel that they are too young to understand, and shielding them from the news will be better in the long run. However, kids can often sense when something is “off” with a loved one, and avoiding the situation can result in mistrust and fear at a time when children will need to feel even more comfortable and secure in their surroundings.

Without proper information, children may:

  • Feel anxious about the changes taking place
  • Imagine something worse is going on than reality
  • Believe that whatever is going on is too scary to talk about
  • Feel as if they are being punished
  • Feel left out and isolated from the family
  • Find it difficult to trust you when they do find out

Age matters

Your child’s age, coping skills, constitution, and level of maturity are important factors in how you approach the situation. Children of any age may regress or act younger when under stress. Their behaviors may become exaggerated for a period of time. For example, a three-year-old child may begin wetting the bed again or return to thumb sucking as a coping mechanism. Children who have problems paying attention in school may have even more difficulty concentrating than before.

Depending on their age group, the following are common ways a child may handle a parent’s cancer diagnosis:

  • Small children will not understand the concept of cancer. They tend to focus on the cancer side effects they can see, such as hair loss. Young children also tend to believe they are the center of the world. It is common for them to assume they are to blame for the cancer because of something they thought, said or did. They also fear separation and being left alone. Since small children are often unable to express how they are feeling in words, you can get an idea about what is going on by watching their behavior, including changes in their play. They may suddenly have fears of the dark, of monsters, animals or strangers. Nightmares and trouble sleeping may also occur.
  • School-aged children will understand more and have a basic knowledge of the human body. They will need clear and simple explanations since they still don’t have the focus of adults. They may be disturbed by a change in the daily routine and they may look for ways to help you. Children of this age may also be reluctant to discuss their feelings because they are afraid of adding to a hardship. Upon hearing the news, they may go off and play and react later. School-aged children may feel anxiety, jealousy and separation anxiety. They may also suffer from poor concentration at school which can result in poor grades.
  • Teenagers have likely heard about cancer and may want to know more detailed information about the disease. They may also be afraid to upset you by asking questions or bringing up your diagnosis. Teenagers present special challenges because of their need for independence and space. They may feel guilty about wanting to get away when they feel they should be at home. In addition, their emotions are often complicated. They may feel it is childish to show their feelings at a time when they want to appear grown up. They often want to be more independent and treated like an adult. They can end up feeling angry, rebellious, depressed, withdrawn and apathetic.

Maintaining normalcy

One important way to help children cope when a parent has cancer is to maintain family time and change their routine as little as possible. Since children rely on structure, trying to keep their lives “normal” helps them feel secure.

“Preston was in basketball when I was going through treatment. There were days when I was really tired, but I knew he wanted me to take him to practice,” says Rod Echols. “So I would try to rest up beforehand so I could still be there for him. I tried to make it as normal as possible, making every day the best day I could possibly make it even on the days I was tired.”

It’s also important not to treat cancer as a family secret, according to Dr. Wakefield, psychologist at our hospital in Tulsa. “Let your children know that it is ok to talk to other important people in their life about cancer. Your children may ask questions and share their feelings with members of their support network,” says Dr. Wakefield. “You may want to contact these people in advance to give them the appropriate information, and ask them to be sensitive to your children’s needs,” he says.

You may encounter times when you don’t know what to say. It is understandable that you may not be prepared for every situation. Although cancer is disruptive and overwhelming, it doesn’t change the fact that you know your children best. Trust your judgment about how best to support them during this difficult time.

How to help a child cope when a parent has cancer

Dr. Wakefield recommends making communication with a child a priority. Make sure you not only talk about cancer, but about other things going on in the child’s life as well:

  • Open the door for communication to occur. This will help them feel more comfortable and in the know.
  • Let your kids ask questions. They may overhear you talking to others, and if they aren’t able to ask about what they’ve heard, they may invent their own explanations.
  • Take every opportunity to communicate. Always give them accurate information they will understand.
  • Be honest and maintain trust. It is ok if you don’t know the answer to their questions. It can be something you discover together.
  • Explain how cancer may affect you or them. Prepare them for changes that might occur, such as hair loss or loss of energy. Assure them that their needs will still be met despite these changes.
  • Ask them what they know. You may assume younger children don’t have a good grasp on what cancer is, but you may be surprised as to how much they have picked up. This also allows you to clear up misinformation they may have learned from others.
  • Show your love and affection for them.  Let them know that their needs are still very important to you. Explain that your health may have changed, but your love hasn’t.
  • Be prepared to listen to your child’s concerns and emotions. And in turn, express your feelings with them. This models that it is ok to talk about how you feel.
  • Consider having your child speak with a counselor, which can be a support system for them as you go through treatment.
  • Reassure your children that they did not cause your cancer. Explain that sometimes events happen in life that we cannot explain.
  • Communicate with your children’s teachers and school counselors about your medical condition. They will be able to support them at school and also inform you if your child shows signs of significant changes in behavior or mood.
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